Sec. 15. (a) As used in this section, "child" means an individual who is less than nineteen (19) years of age.
(b) As used in this section, "enrollee" means an enrollee who is a child or an individual:
(1) with a physical or mental impairment that substantially limits one (1) or more of the major life activities of the individual; and
(2) who:
(A) has a record of; or
(B) is regarded as;
having an impairment described in subdivision (1).
(c) A health maintenance organization that provides basic health care services shall include coverage under the terms and conditions of the benefits contract for anesthesia and hospital charges for an enrollee for dental care if the mental or physical condition of the enrollee requires dental treatment to be rendered in a hospital or an ambulatory outpatient surgical center. The Indications for General Anesthesia, as published in the reference manual of the American Academy of Pediatric Dentistry, are the utilization standards for determining whether performing dental procedures necessary to treat the enrollee's condition under general anesthesia constitutes appropriate treatment.
(d) A health maintenance organization may:
(1) require prior authorization for hospitalization or treatment in an ambulatory outpatient surgical center for dental care procedures in the same manner that prior authorization is required for hospitalization or treatment of other covered medical conditions; and
(2) restrict coverage to include only procedures performed by a licensed dentist who has privileges at the hospital or ambulatory outpatient surgical center.
(e) This section does not apply to treatment rendered for temporal mandibular joint disorders (TMJ).
As added by P.L.189-1999, SEC.3.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage
27-13-7-0.1. Application of Certain Amendments to Chapter
27-13-7-1. Persons Entitled to Copies of Contracts
27-13-7-2. Deceptive Contract Provisions Prohibited
27-13-7-3. Contract Provisions
27-13-7-4. Compliance With Requirements; Ten Day Grace Period
27-13-7-5. Evidence of Coverage
27-13-7-6. Evidence of Coverage; Prohibited Provisions
27-13-7-7. Evidence of Coverage; Required Statement
27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement
27-13-7-8. Readability Standards
27-13-7-9. Approval of Forms by Commissioner
27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required
27-13-7-12. Additional Information Required by Commissioner
27-13-7-13. Continuation of Coverage Statement
27-13-7-14. Post-Mastectomy Coverage
27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity
27-13-7-14.7. Coverage for Autism Spectrum Disorders
27-13-7-15. Dental Care Provisions Required
27-13-7-15.3. Breast Cancer Screening Mammography
27-13-7-16. Prostate Specific Antigen Test
27-13-7-17. Coverage for Colorectal Cancer Screening; Exception for Grandfathered Health Plans
27-13-7-18. Inherited Metabolic Disease Coverage
27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices
27-13-7-20. Prohibition on Chemotherapy Coverage Limitations
27-13-7-20.2. Coverage for Care Related to Cancer Clinical Trials
27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain
27-13-7-21. High Breast Density
27-13-7-23. Step Therapy Protocol
27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
27-13-7-24.5. Coverage for Chronic Pain Management
27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders